Camouflage, Psychotherapy with Vitiligo Management Improves Patient Care

New data suggest a combination of cosmetic and psychiatric care for patients with the chronic pigmentation condition may provide multi-systemic benefit.

Camouflage plus psychotherapy may be a significantly beneficial and comprehensively modulating treatment for patients undergoing vitiligo management.

In new research from investigators in China, the practice of pigmentation camouflage—a common cosmetic strategy for patients with vitiligo in regions including China—in combination with psychotherapy provided perceptible improvements to the network psychiatric, neurological, endocrine, immunologic and dermatologic outcomes associated with managing the chronic skin pigmentation condition.

Led by Yuqian Chang, of the department of dermatology in Xijing Hospital in Xi’an, investigators sought to investigate the joint efficacy and multi-system interactions of camouflage plus psychotherapy in patients with vitiligo. The team cited a recently innovative trial demonstrating association between stress and the release of norepinephrine from sympathetic nerves—which then leads to melanocyte stems cells to convert to pigment production and eventually induce the graying of hair.”

“These findings prompt us to investigate the importance of maintaining a positive psychological state in the selection of management modalities,” they wrote. “Camouflage treatment has always been considered a dispensable cosmetic option for many patients in China based on our clinical observations because of lack of corresponding psychological construct and clear mechanism statement when patients are recommended to apply masking agents.”

Chang and colleagues conducted a prospective, non-randomized, concurrent trial involving 238 patients with non-segmental vitiligo recruited from Xijing Hospital. Patients were 18-60 years old, with vilitiginous patches visible on their exposed skin.

Key exclusion criteria included certain topical inhibitor therapy or immunosuppressant treatment regimens, experience with camouflage products, psychiatric or mental health illnesses, concomitant autoimmune skin disorders, etc.

Patients were selected into either an intervention arm including conventional medical treatment plus camouflage and a trial outcome-specific psychotherapy program, or a control arm of lone conventional treatment. Investigators sought blood serum-based outcomes for neuropeptide and cytosine change via immunosorbent assay, and quality of life was evaluated via Vitiligo Life Quality Index - China (VLQI-C).

The final evaluation included 149 patients in the trial. The team observed significant total and subcategory quality-of-life score improvements among the intervention group versus control group after 4 weeks of treatment. Neuropeptide and melanin-concentrating hormone serum less significantly decreased, and adrenocorticotropic hormone (ACTH) increased in the intervention arm.

Patients in the treatment arm additionally reported improved mean serum levels for interferon-γ , CXC chemokine ligand 10, and interleukin-1β.

“In our previous study, we have demonstrated increased serum IL-1β levels in patients with vitiligo and correlated it with disease activity and severity, as well as a decrease after routine care,” investigators noted. “These findings will help us understand the potential psycho-neuro-endocrine-immuno-skin system mechanism in management of vitiligo.”

The team concluded that camouflage plus psychotherapy, when added on to standard care, improves both quality of life outcomes and complements systemic interactions associated with vitiligo management.

“Dermatologists should be aware of the importance of easing psychosocial burdens using cover products and psychological support during treatment of vitiligo,” they wrote.

The study, “The Efficacy and Psychoneuroimmunology Mechanism of Camouflage Combined With Psychotherapy in Vitiligo Treatment,” was published online in Frontiers in Medicine.